Effects on mortality of early vs late administration of convalescent plasma in the treatment of Covid-19.

The pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first seen in the city of Wuhan, China, in December 2019 and then spread worldwide. On 24 March 2020, the U.S. Food and Drug Administration reported that the use of convalescent plasma (CP) containing antibodies against COVID-19 could be effective against infection. The aim of this study is to retrospectively investigate whether early CP transfusion treatment has an effect on recovery of clinical and laboratory parameters in patients diagnosed with severe COVID-19 who were admitted to the intensive care unit (ICU). The study included 141 consecutive patients who had laboratory confirmation of COVID-19 and were admitted to the ICU between 1 May and 30 September 2020. Of the 141 patients, 84 received CP in the first five days of hospitalization in the ICU (early group), and 57 received CP after the fifth day of hospitalization in the ICU (late group). There were no significant differences between the two groups in terms of age, gender, comorbidities and the severity of the disease (according to the evaluation of lung tomography). There was no difference between the two groups in terms of mechanical ventilator needed, inotrope support, and tracheostomy procedure during the ICU admission (p = 0.962, p = 0.680, and p = 0.927, respectively). Despite these limitations, the overriding result of our study is that it suggests that administration of CP either early or late in the treatment of COVID-19, had no effect on mortality.

Observational study of the effects of Favipiravir vs Lopinavir/Ritonavir on clinical outcomes in critically Ill patients with COVID-19.

WHAT IS KNOWN AND OBJECTIVES: In November 2019, several patients were diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Wuhan, China. So far, there are no specific treatments with proven high efficacy in patients with SARS-CoV-2. Presently, several drugs, such as hydroxychloroquine, ribavirin, favipiravir (FVP), lopinavir/ritonavir (LPV/r), remdesivir and oseltamivir, have been suggested as effective treatments for SARS-CoV-2. The aim of this study was to describe the clinical experience with FPV and LPV/r in critically ill patients with COVID-19 at Sakarya University Education and Research Hospital. METHODS: The study included 107 consecutive patients who had a laboratory confirmation of COVID-19 and were admitted to the intensive care unit (ICU) between 19 March and 19 May 2020. Follow-up continued through 30 May 2020 when the last observed patients were discharged. RESULTS AND DISCUSSION: Of the 107 patients, 65 received FPV (Group FPV) and 42 received LPV/r (Group LPV/r). The two groups were similar in terms of demographic data and clinical findings. 43 (66.2%) of the 65 patients in the FPV group and 23 (54.8%) of the 42 patients in the LPV/r group died (p = 0.237). The median ICU stay was 6.6 (IQR, 3-10) days in the FPV group and 9 (IQR, 6-16) days in the LPV/r group, which was a statistically significant difference (p = 0.010). WHAT IS NEW AND CONCLUSION: The length of hospital stay was significantly lower in the FVP group compared to the LPV/r group among patients who were discharged from the ICU. Although the analysis was done with a limited number of patients and the observed difference in mortality rate is of some concern, FVP treatment may be more beneficial than LPV/r in terms of effective use in the ICU.

Efficacy of convalescent plasma according to blood groups in COVID-19 patients

Background/aim: In this study, we aim to investigate the efficacy of convalescent plasma (CP) according to blood groups (BGs) in the treatment of critically ill patients diagnosed with COVID-19. Materials and methods: Twenty-eight critically ill and laboratory-confirmed COVID-19 patients who were admitted to the intensive care unit (ICU) of Sakarya University, Medical Faculty were included in the study. Patients were divided into 2 groups: patients who received anti-A antibody (Ab) containing CP (BG O and B) and those who did not receive CP containing anti-A Ab (BG A and AB). Results: Among the 28 patients, 13 patients received anti-A Ab containing CP (BG; B: 6, O: 7) and 15 patients did not receive anti-A Ab CP (BG; A: 13, AB: 2). Duration in ICU, the rates of mechanical ventilation (MV) support and vasopressor support, the case fatality rate, and the discharge rate were lower in patients who received CP containing anti-A Ab than not containing anti-A Ab CP. However, only the difference in the rate of MV support achieved statistically significance (P = 0.04) Conclusion: In our study, it was observed that the efficiency of CP without anti-A antibody was lower than that of plasma containing anti-A antibody, although it was not statistically significant. This result is thought to be due to the anti-A antibody's ability to block the ACE2 receptor. We believe that this hypothesis should be investigated in controlled studies with higher patient numbers.

Characteristics and outcomes of critically ill patients with covid-19 in Sakarya, Turkey: a single centre cohort study

Background/aim: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first reported in Turkey on March 10, 2020 and the number of the patients are increasing day by day. Coronavirus disease 2019 (Covid-19) has high mortality rates in intensive care units (ICUs). We aimed to describe the demographic characteristics, comorbidities, treatment protocols, and clinical outcomes among the critically ill patients admitted to the ICU of our hospital. Materials and methods: This cohort study included 103 consecutive patients who had laboratory confirmed Covid-19 and admitted to ICU of Sakarya University Training and Research Hospital between March 19 and April 13, 2020. The final date of the follow-up was April 18. Results: The mean age of the patients was 69.6 ± 14.1 years. Most of the patients had increased CRP (99%), serum ferritin (73.8%), d-dimer (82.5%), and hs-troponin levels (38.8%). 34 patients (33%) had lymphocytopenia, 24 patients (23.3%) had thrombocytopenia. 63 patients (61.2%) developed acute respiratory distress syndrome (ARDS), 31 patients (30.1%) had acute kidney injury, and 52 patients (50.5%) had multiple organ dysfunction syndrome (MODS) during follow-up. Sixty-two patients (60.2%) received mechanical ventilation. As of April 18, of the 103 patients, 52 (50.5%) had died, 30 (29.1%) had been discharged from the ICU, 21 (20.4%) were still in the ICU. Conclusions: Covid-19 has high mortality rates in ICU. Patients with elevated procalcitonin, hs-troponin, d-dimer, and CRP levels and lower platelet count at admission have higher mortality.

Clinical course of COVID-19 disease in immunosuppressed renal transplant patients

Background/aim: We aimed to identify clinical settings of renal transplant patients with COVID-19. Materials and methods: In this retrospective study, we included kidney transplant inpatients with laboratory confirmed COVID-19 who had been discharged or had died by October 1st, 2020. Characteristics of the patients, including basal and last outpatient biochemical parameters were recorded. Discontinuation or dosage reduction of immunosuppressives and other treatment information was documented. Results: Twenty patients were included in this study, of whom 18 were discharged and 2 died in hospital. The mean duration of hospitalization and follow-up were 9.7 ± 6.4 days and 4.5 ± 2.0 months, respectively. Fourteen patients (70%) were male and mean age was 48.0 ± 10.3 years. At admission, all had immunosuppression withdrawn and were started on methylprednisolone 16 mg/ day (50%) or dexamethasone (50%). Tacrolimus/m-TOR inhibitors were reduced by 50% and all antimetabolites were discontinued. Hemodialysis was needed for 10% of patients. Acute kidney injury was detected in 25% of the patients. With respect to hospitalization time and complications, there was no significant difference between patients who used dexamethasone and those who did not (P > 0.05). The discontinued immunosuppressives were resumed within 2 to 4 weeks after discharge according to the severity of disease. No rehospitalization or acute rejection was detected during the follow-up of the patients. Conclusion: Renal transplant patients are considered a high risk group for COVID-19. It can be said that discontinuation or reducing dosages of immunosuppressives may be effective and safe in kidney transplant patients.

The usual course of thorax CT findings of COVID-19 infection and when to perform control thorax CT scan

COVID-19 infection, a highly contagious disease caused by the SARS-CoV virus, and the World Health Organization declared this increasingly spreading disease as a global public health emergency (pandemic). In the diagnosis of COVID-19, the polymerase chain reaction (RT-PCR) is considered as the reference standard test. In the early stages, thorax CT findings could be present even before the onset of symptoms, thorax CT has quite high sensitivity in COVID-19 patients with false negative RT-PCR results, and it has a great importance not only in diagnosis but also in follow up. We think that it might be beneficial for our radiologist colleagues in the early diagnosis of the imaging features of this disease, by sharing the experiences we have gained by evaluating the typical and relatively atypical CT findings regarding the natural course of the tomographic findings of COVID-19 and when to control CT.

Effect of controlled hypotension on regional cerebral oxygen saturation during rhinoplasty: a prospective study.

The aim of this study was to investigate the effect of controlled hypotension on cerebral oxygen saturation (rSO2) using near infrared spectroscopy (NIRS) and evaluation of postoperative cognitive function in patients undergoing rhinoplasty. Fifty adult patients who were scheduled for elective rhinoplasty surgery and required controlled hypotension were enrolled in this prospective study. Controlled hypotension was provided using a combination of propofol and remifentanil infusion supplemented with nitroglycerin infusion as necessary. rSO2 was evaluated during controlled hypotension by NIRS. Cerebral desaturation was observed in 5 out of 50 patients (10 %) during hypotensive anesthesia. The greatest decrease from baseline was 28 % when MAP was 57 mmHg. In both non-desaturated and desaturated patients, postoperative MMSE scores were significantly lower than preoperative scores. There was a 4 % decrease in the non-desaturated patients and a 7 % decrease in the desaturated patients when preoperative and postoperative MMSE scores were compared. A decline in cognitive function 1 day after surgery was observed in 23 patients (46 %) and in all patients with intraoperative cerebral desaturation. The current study showed that even if SpO2 is in the normal range, there might be a decrease of more than 20 % in cerebral oxygen saturation during controlled hypotension.

Effect of cooled hyperbaric bupivacaine on unilateral spinal anesthesia success rate and hemodynamic complications in inguinal hernia surgery.

PURPOSE: We hypothesized that cooling hyperbaric bupivacaine from 23 to 5 °C may limit the intrathecal spread of bupivacaine and therefore increase the success rate of unilateral spinal anesthesia and decrease the rate of hemodynamic complications. METHODS: A hundred patients scheduled for elective unilateral inguinal hernia surgery were randomly allocated to receive 1.8 ml of 0.5 % hyperbaric bupivacaine intrathecally at either 5 °C (group I, n = 50) or at 23 °C (group II, n = 50). Following spinal block at the L2-3 interspace, the lateral decubitus position was maintained for 15 min. Unilateral spinal anesthesia was assessed and confirmed at 15 and 30 min. The levels of sensory and motor block on the operative side were evaluated until complete resolution. RESULTS: The rate of unilateral spinal anesthesia at 15 and 30 min was significantly higher in group I (p = 0.015 and 0.028, respectively). Hypotensive events and bradycardia were significantly rarer in group I (p = 0.014 and 0.037, respectively). The density and viscosity of the solution at 5 °C was significantly higher than at 23 °C (p < 0.0001). Compared with group II, sensory block peaked later in group I (17.4 vs 12.6 min) and at a lower level (T9 vs T7), and two-segment regression of sensory block (76.4 vs 84.3 min) and motor block recovery was shorter (157.6 vs 193.4 min) (p < 0.0001). CONCLUSIONS: Cooling of hyperbaric bupivacaine to 5 °C increased the density and viscosity of the solution and the success rate of unilateral spinal anesthesia, and decreased the hemodynamic complication rate.

A novel model approach for esophageal burns in rats: A comparison of three methods.

BACKGROUND: Corrosive esophageal injury causes serious clinical problems. We aimed to create a new experimental esophageal burn model using a single catheter without a surgical procedure. MATERIALS AND METHODS: We conducted the study with two groups of 12 male rats that fasted for 12 h before application. A modified Foley balloon catheter was inserted into the esophageal lumen. The control group was given 0.9% sodium chloride, while the experimental group was given 37.5% sodium hydroxide with the other part of the catheter. After 60s, esophagus was washed with distilled water. The killed rats were examined using histopathological methods after 28 days. RESULTS: In comparison with the histopathological changes experienced by the study groups, the control groups were observed to have no pathological changes. Basal cell degeneration, dermal edema, and a slight increase in the keratin layer and collagen density of submucosa due to stenosis were all observed in the group subjected to esophageal corrosion. CONCLUSION: A new burn model can thus, we believe, be created without the involvement of invasive laparoscopic surgery and general anesthesia. The burn in our experiment was formed in both the distal and proximal esophagus, as in other models; it can also be formed optionally in the entire esophagus.

Effect of sugammadex on rocuronium induced changes in pancreatic mast cells.

Mast cells play a vital role in hypersensitivity reactions. Rocuronium is known to cause mast cell mobilization, hypersensitivity, and pancreatitis. The aim of this study was to investigate the effects of sugammadex on pancreatic changes due to rocuronium. A total of 42 Sprague-Dawley male rats were divided into six equal groups to receive either rocuronium 1 mg/kg intravenously (i.v., R group), rocuronium 1 mg/kg + sugammadex 16 mg/kg i.v. (RS16 group), rocuronium 1 mg/kg + sugammadex 96 mg/kg i.v. (RS96 group), sugammadex 16 mg/kg (S16), sugammadex 96 mg/kg i.v. (S96 group), or 0.9% sodium chloride (control group). Sugammadex was administered 5s later following rocuronium. In R group, mast count was higher, and the distribution rate of granules and nuclear changes were different compared with other groups. Distribution rate of granules in groups S16 and S96 were similar to the control group and lower compared with other groups. The amount of mast cells and granule density in groups RS16 and RS96 was lower compared with R group. The amount of mast cells in groups RS16 and RS96 was significantly lower compared with other treatment groups. These results suggest that sugammadex may have an inhibitory effect on mobilization and morphological changes in pancreatic mast cells induced by administration of rocuronium and sugammadex in rats.

The interrelations of radiologic findings and mechanical ventilation in community acquired pneumonia patients admitted to the intensive care unit: a multicentre retrospective study.

BACKGROUND: We evaluated patients admitted to the intensive care units with the diagnosis of community acquired pneumonia (CAP) regarding initial radiographic findings. METHODS: A multicenter retrospective study was held. Chest x ray (CXR) and computerized tomography (CT) findings and also their associations with the need of ventilator support were evaluated. RESULTS: A total of 388 patients were enrolled. Consolidation was the main finding on CXR (89%) and CT (80%) examinations. Of all, 45% had multi-lobar involvement. Bilateral involvement was found in 40% and 44% on CXR and CT respectively. Abscesses and cavitations were rarely found. The highest correlation between CT and CXR findings was observed for interstitial involvement. More than 80% of patients needed ventilator support. Noninvasive mechanical ventilation (NIV) requirement was seen to be more common in those with multi-lobar involvement on CXR as 2.4-fold and consolidation on CT as 47-fold compared with those who do not have these findings. Invasive mechanical ventilation (IMV) need increased 8-fold in patients with multi-lobar involvement on CT. CONCLUSION: CXR and CT findings correlate up to a limit in terms of interstitial involvement but not in high percentages in other findings. CAP patients who are admitted to the ICU are severe cases frequently requiring ventilator support. Initial CT and CXR findings may indicate the need for ventilator support, but the assumed ongoing real practice is important and the value of radiologic evaluation beyond clinical findings to predict the mechanical ventilation need is subject for further evaluation with large patient series.

Relationship between platelet indices and red cell distribution width and short-term mortality in traumatic brain injury with 30-day mortality.

OBJECTIVE: This study aimed at investigating whether there is a relationship between 7- or 30-day mortality and mean platelet volume, platelet distribution width, platelet count-to-total lymphocyte count ratio, or red cell distribution width in patients with traumatic brain injury. METHODS: We retrospectively analyzed intensive care unit patients with traumatic brain injury. We recorded patients' ages; genders; diagnoses; Glasgow Coma Scale scores; length of intensive care unit stay (in days); mean platelet volume, platelet distribution width, platelet count-to-total lymphocyte count ratio, and red cell distribution width values upon hospital admission; and health on the 7th and 30th days of their stays. RESULTS: We analyzed data from 110 patients. Of these, 84 (76.4%) were male and 26 (23.6%) were female. On the 7- and 30-day mortality evaluations, compared to the living patients, the deceased patients had a significantly higher median age and a significantly lower median Glasgow Coma Scale. Thus, increased age and lower Glasgow Coma Scale scores were associated with increased 7- and 30-day mortality rates. mean platelet volume and platelet distribution width values were similar in living and deceased patients. platelet count-to-total lymphocyte count ratio values were lower in deceased patients, but this difference was not statistically significant. Within 30 days after traumatic brain injury, deceased patients' red cell distribution width values were significantly elevated in deceased patients compared to those of living patients. CONCLUSION: Mean platelet volume, platelet distribution width, and platelet count-to-total lymphocyte count ratio values were not associated with 7- and 30-day mortality, whereas only elevated red cell distribution width was associated with 30-day mortality.

Does the variant positivity and negativity affect the clinical course in COVID-19?: A cohort study.

The primary aim of the current study is to analyze the clinical, laboratory, and demographic data comparing the patients with Coronavirus Disease 2019 (COVID-19) admitted to our intensive care unit before and after the UK variant was first diagnosed in December 2020. The secondary objective was to describe a treatment approach for COVID-19. Between Mar 12, 2020, and Jun 22, 2021, 159 patients with COVID-19 were allocated into 2 groups: the variant negative group (77 patients before December 2020) and the variant positive group (82 patients after December 2020). The statistical analyses included early and late complications, demographic data, symptoms, comorbidities, intubation and mortality rates, and treatment options. Regarding early complications, unilateral pneumonia was more common in the variant (-) group (P = .019), whereas bilateral pneumonia was more common in the variant (+) group (P < .001). Regarding late complications, only cytomegalovirus pneumonia was observed more frequently in the variant (-) group (P = .023), whereas secondary gram (+) infection, pulmonary fibrosis (P = .048), acute respiratory distress syndrome (ARDS) (P = .017), and septic shock (P = .051) were more common in the variant (+) group. The therapeutic approach showed significant differences in the second group such as plasma exchange and extracorporeal membrane oxygenation which is more commonly used in the variant (+) group. Although mortality and intubation rates did not differ between the groups, severe challenging early and late complications were observed mainly in the variant (+) group, necessitating invasive treatment options. We hope that our data from the pandemic will shed light on this field. Regarding the COVID-19 pandemic, it is clear that there is much to be done to deal with future pandemics.

The effect of rocuronium, sugammadex, and their combination on cardiac muscle and diaphragmatic skeletal muscle cells.

PURPOSE: Rocuronium has been associated with muscle weakness when administered in prolonged infusions. The effect of sugammadex and rocuronium together on muscle is unknown. In this study, we examined the effects of rocuronium and sugammadex, and the complex formed by these agents, on cardiac and diaphragmatic muscle cells. METHODS: Forty-two Sprague-Dawley male rats were divided into six groups. Group I received only rocuronium at a dose of 1 mg/kg and groups II and III received sugammadex alone at doses of 16 and 96 mg/kg, respectively. Groups IV and V received 1 mg/kg rocuronium plus 16 mg/kg sugammadex and 1 mg/kg rocuronium plus 96 mg/kg sugammadex, respectively. Group six was the control group and received only 0.9 % NaCl without any drug. RESULTS: Histopathological examination demonstrated that rocuronium and high doses of sugammadex accumulated in both cardiac and diaphragm muscle tissues. We also observed intense edema and degeneration in diaphragmatic and myocardial cells when the rocuronium-sugammadex complex was used. Rocuronium and sugammadex remain in the circulation for a long time and they may cause skeletal muscle myopathy, vacuolization, pyknotic nuclear clumps, and hypertrophy, and weaken the muscle fibers. CONCLUSION: Rocuronium, sugammadex, and rocuronium-sugammadex complexes cause histopathological changes and immunoreactivity to calcineurin in muscle cells.

Effects of dexmedetomidine on new oxidative stress markers on renal ischaemia-reperfusion injury in rats: thiol/disulphide homeostasis and the ischaemia-modified albumin.

OBJECTIVES: This study investigated the effect of dexmedetomidine on the oxidant-antioxidant (thiol/disulphide) balance. METHODS: A total of 24 rats were divided into four groups. The renal arteries in groups IR (ischaemia/reperfusion) and IR + D (ischaemia/reperfusion + dexmedetomidine) were clamped for 45 min and reperfused for 180 min. Groups D (Dexmedetomidine) and IR + D were administered 100 µg/kg dexmedetomidine. Oxidant-antioxidant (thiol/disulphide) levels were measured. Kidney tissue was examined histopathologically. RESULTS: No statistically difference was found between the groups in terms of thiol-disulphide averages, while IMA, TOS and thiol-disulphide results showed a minimal decrease in Group IR + D compared to Group IR (p > 0.05). Tubular lesions and necrosis were found in 26-50% of tubules in Group IR. Tubular damage and necrosis in Group IR + D declined to 5-25% . CONCLUSIONS: No statistically difference was found in the study where OSI index, thiol/disulphide balance and IMA were measured together as biochemical values.

Reversal of rocuronium-induced neuromuscular block with sugammadex and resulting histopathological effects in rat kidneys.

BACKGROUND: This study investigated the effect of injection of rocuronium or sugammadex alone and rocuronium + sugammadex on urea, creatinine, electrolyte levels, and histopathological findings in rats. METHODS: Thirty-six Sprague-Dawley male rats were divided to receive intravenously 16 or 96 mg/kg sugammadex, 1 mg/kg rocuronium, 1 mg/kg rocuronium + 16 mg/kg sugammadex, or 1 mg/kg rocuronium + 96 mg/kg sugammadex. The control group received an equal volume of physiological serum. Rats receiving rocuronium were ventilated until resumption of spontaneous ventilation and followed for 72 h. Blood samples were withdrawn from the tail vein to measure urea, creatinine, and electrolyte values; then both kidneys were excised, and the tissues were used for histopathological examination. RESULTS: Rats receiving rocuronium and high doses of sugammadex (96 mg/kg) showed increased glomerular vacuolation, tubular dilatation, vascular vacuolation and hypertrophy, lymphocyte infiltration, and tubular cell sloughing compared to the control group (p = 0.002). Biochemical markers of renal function were not significantly altered after treatment with high doses of sugammadex. CONCLUSION: The elimination half-life of the rocuronium-sugammadex complex was found to be greater than that of free rocuronium or sugammadex, which led to marginal histopathological changes in the kidney without affecting any renal functions.

Percutaneous Dilational Tracheostomy in a Patient With SARS-CoV-2 (COVID-19) Disease: A Case Report With Implications in Staff Safety.

Some patients may need mechanical ventilation support during severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease-2019, COVID-19) infection and may eventually require tracheostomy in the following days. Tracheostomy is considered as a high-risk procedure for surgeons and operative personnel in terms of air contamination. We present a case of percutaneous dilational tracheostomy performed in a patient with COVID-19 pneumonia and the methods we used to reduce contamination risks for the healthcare staff.

Neurological Outcomes of Normothermia versus Targeted Temperature Management in Post-cardiac Arrest Syndrome.

OBJECTIVE: To determine the neurological outcome of targeted temperature management (TTM)for patients scoring lower than 8 on the Glasgow coma scale (GCS) upon return of spontaneous circulation (ROSC) after cardiac arrest. STUDY DESIGN: Retrospective cohort study. PLACE AND DURATION OF STUDY: Department of Anaesthesiology and Reanimation, Sakarya University Education And Research Hospital, Sakarya, Turkey from January 2018 to October 2019. METHODOLOGY: Data of patients hospitalised in the AnaesthesiaIntensive Care unit for cardiac arrest receiving TTM and standard supportive therapy were analysed. Neurological outcome was evaluated with cerebral performance category (CPC) scores. Hospital stay and 30-day mortality was also noted. RESULTS: Data from 58 patients were analysed; 31 had received standard supportive therapy (non-TTM group) and 27 were treated with TTM (TTM group). There was no significant difference in hospital stay and patients' 30-day mortality between the two groups. The number of patients in the TTM group with CPC scores of 1 and 2, rated as a good neurological result, was significantly higher (n=11,40.7%) than in the non-TTM group (n=2, 6.5%;p=0.002). The number of patients with CPC scores of 3 and 4, rated as having a neurological disability,was higher in the non-TTM group (n = 9, 29%) than in the TTM group (n=1, 3.7%). CONCLUSION: Neurological results were better in the TTM group of patients with ROSC. However, there was no significant difference in mortality between the TTMand non-TTM groups. Key Words: Targeted temperature management, Cardiac arrest, Neurological outcome, Cerebral performance category.

Compliance With the Surviving Sepsis Campaign Bundle: A Multicenter Study From Turkey.

Objectives Sepsis bundle compliance is not clear. We evaluated rates of compliance with sepsis bundle protocols among health care providers in Turkey. Methods Our study was carried out retrospectively. Forty-five intensive care units (ICU) participated in this study between March 2, 2018 and October 1, 2018. Results One hundred thirty-eight ICUs were contacted and 45 ICUs agreed to participate. The time taken for the diagnosis of sepsis was less than six hours in 384 (59.8%) patients, while it was more than six hours in 258 (40.2%) patients. The median [interquartile range (IQR)] times for initial antibiotic administration, culturing, vasopressor initiation, and second lactate measurement were 120.0 (60-300) minutes, 24 (12-240) minutes, 40 (20-60) minutes, and 24 (18-24) hours, respectively. The rate of compliance with tissue and organ perfusion follow-up in the first six hours was 0%. The rates of three- and six-hour sepsis bundle protocol compliance were both 0%. The ICU mortality rates for sepsis and septic shock were 22% and 78%, respectively. The ICU mortality rates for sepsis and septic shock were 22% and 78%, respectively. Conclusions The rate of compliance with sepsis bundle protocols was evaluated in Turkey for the first time and determined to be 0%.

Evaluation of the incidence, characteristics, and outcomes of pediatric chronic critical illness.

Our aim was to determine characteristics of children with chronic critical illness (CCI) admitted to the pediatric intensive care unit (PICU) of a tertiary care children's hospital in Turkey. The current study was a multicenter retrospective cohort study that was done from 2014 to 2017. It involved three university hospitals PICUs in which multiple criteria were set to identify pediatric CCIs. Pediatric patients staying in the ICU for at least 14 days and having at least one additional criterion, including prolonged mechanical ventilation, tracheostomy, sepsis, severe wound (burn) or trauma, encephalopathy, traumatic brain injury, status epilepticus, being postoperative, and neuromuscular disease, was accepted as CCI. In order to identify the newborn as a chronic critical patient, a stay in the intensive care unit for at least 30 days in addition to prematurity was required. Eight hundred eighty seven (11.14%) of the patients who were admitted to the PICU met the definition of CCI and 775 of them (87.3%) were discharged to their home. Of CCI patients, 289 (32.6%) were premature and 678 (76.4%) had prolonged mechanical ventilation. The total cost values for 2017 were statistically higher than the other years. As the length of ICU stay increased, the costs also increased. Interestingly, high incidence rates were observed for PCCI in our hospitals and these patients occupied 38.01% of the intensive care bed capacity. In conclusion, we observed that prematurity and prolonged mechanical ventilation increase the length of ICU stay, which also increased the costs. More work is needed to better understand PCCI.